Chronic Back Pain

Back pain won’t go away?

If your pain came on within the past 6 weeks or so, please see my page on acute back pain. What if you are one of the unlucky people who have back pain that won’t go away? What if the pain came on gradually and then just stayed? Sometimes it becomes clear that simply controlling the symptoms isn’t enough. Something needs to be done about the problem. Of course, in order to do something, we first need to come up with a diagnosis. There are several ways I can figure out what is wrong:

HISTORY

Although it may seem like a “duh” thing, it can be very helpful to get the answers to simple questions like “where is the pain?”, “where does it travel?”, “what makes it better?”, “what makes it worse?”, etc. Certain conditions have a classic presentation in history. For instance, if you have pain in your right hip and buttock area, it could be hip arthritis or sciatica (leg pain coming from your back). If you have pain in the groin area when first starting up from a chair or bed, it is more likely to be the hip. If you have pain that gradually gets worse as you walk, then it may be coming from your back. Obviously, history doesn’t clinch the diagnosis. But, it is important in providing the first clues.

PHYSICAL EXAM

Even though we have a lot of fancy tests these days, the simple “laying on of hands” can tell a lot. It gives us a general idea of where the problem is, and suggests what to get tests on. Without a physical exam, we could easily go “barking up the wrong tree.” An example: it is unfortunately not that uncommon for a patient to present to my office complaining of “sciatica” from his or her back. Often, they present with an MRI of the spine that has been read by other doctors as having no problem that needs surgery. Sometimes (and very unfortunately), he or she has had spinal surgery that failed to correct the problem. I do a simple physical exam to check the hip joints: when I rotate the hips, the patient yelps in pain. An x-ray confirms that the problem was the hip all along, not the back. The patient had never had a physical exam before!

X-RAYS

We have an x-ray machine in our office, so it is convenient to get x-rays right at the time of your office visit. Very often, the plain x-ray alone is enough to tell us what the problem is. In this x-ray, the patient has severe bone-on-bone arthritis. If the patient’s history and physical exam is wholly consistent with the x-ray, we may be done with diagnosis. Fancier tests will not be necessary because the x-ray is so obvious. If there are other issues, more extensive testing may be necessary, but it is not a given.

HIGH TECH IMAGING

Most of the time here, we are talking about an MRI scan. It is noninvasive, it doesn’t use radiation, and it will be just about the most sensitive test for problems. There are other tests that could be necessary as well, such as blood work, CT, myelograms, bone scans and other such tests. Each patient will be unique in terms of what tests will be most likely to show the problem the best.

WE HAVE OUR DIAGNOSIS

So, we’ve done our history, our physical exam, and our testing, and now we know what’s wrong. What do we do now? Well, that depends on a few things: what the problem is, how bad the pain is, how long has it been present, and what treatments have been tried before. Even if you have a chronic condition, all of the treatments discussed on my acute low back pain page can be attempted if they haven’t been tried before. This is especially true for physical therapy. Many people have a chronic back problem that is too painful to live with, but not curable. In that case, therapy can be a useful tool to lower the pain from an intolerable range to a tolerable one. Hopefully, a range that you can live with.

But, let’s say that all of our conservative treatments were not sufficiently effective to eliminate the pain, or at least to make it acceptable. What then? Well, this may be a situation in which some form of surgery may be required to help with the problem. The specific surgery will depend on the specific problem.

The great majority of people with back pain have acute attacks that will resolve and never come back. Unfortunately, some people are plagued by pain that persists for months or years, or pain that keeps coming back over and over. We can divide back pain into two basic categories; acute and chronic.

The neck is comprised of 7 bones (vertebrae) that protect the spinal cord. There are pairs of nerves which come out from the spinal cord and run between the vertebra. Also, between the vertebra, there are discs which cushion each bone and provide some shock absorption.

The hip joints are the large weight-bearing junctions of where your leg (femur) and pelvis come together. Just as with any other mobile joint, the hips can become a source of pain. The pain can be caused by injury, wear and tear over time or other disease processes.

The knee joints are hinge-type joints where your upper and lower leg bones come together. Most knee pain has something to do with either the cartilage (otherwise known as the meniscus), the bones, ligaments, tendons, muscles, tissues or a combination of these.

Christine,
I can’t thank you enough for helping me the day I came to the office. You saw I was in extreme pain and needed help and took it upon yourself and assisted me with doing the paperwork. It shows what a special person you are and I again thank you and God for people like you! I can walk, sit and sleep now without pain after surgery.

Truly Grateful, THANK YOU!

Dr. Troy Lowell, Tonya Lowell and Staff,

Words can’t express how grateful I am when you took me in as an emergency patient to help me in my time of desperation with my back. Because you and your staff were able to get me into surgery sooner than I was schedule, cause I could no longer move without extreme pain, I can now walk, sit, sleep and eat when I wasn’t able for 2 weeks prior. I wouldn’t lay down without pain, my legs would hang off the side of our bed to get some relief and that’s how I stayed for two weeks prior to surgery for pinched nerve and fusion in L4, L5 and L5 SI. It’s an incredible feeling to be out of pain!

Deeply Grateful!

I came to Dr. Lowell because the knee replacements I had done several years ago were not working properly for me anymore. At first I was very scared, but Dr. Lowell and his staff allayed all of my fears. I went on to have my surgery, and I must say it was a great experience. I was amazed by how quickly I was able to get back on my feet. Everyone in the office was pleasant and helpful.

S. Chapman

I think Dr. Lowell’s office is wonderful! Dr. Lowell replaced both my knee and my hip. I have a new lease on life because of the work he has done. I now walk 3 miles a day because I no longer have pain. I don’t know what I would have done without their help!

Leonia R.

I am absolutely thrilled with the experience I had with Dr. Lowell and his staff! I loved the staff and the care they gave me. I can not say enough good things about my experience! I am doing wonderful already and it has only been 2 months since my hip replacement!

M. Barone

Dr. Lowell performed a sacroiliac fusion on me due to chronic pain I was having in my left SI join and leg. Following surgery, the pain I was having resolved. I can now walk much better than I was before the surgery!